A dengue à transmitida por mosquitos hematÃfagos do gÃnero Aedes das espÃcies aegypti e albopictus. O vÃrus dengue (DENV) pertence à famÃlia Flaviviridae do gÃnero FlavivÃrus e possui quatro sorotipos que foram designados como: DENV-1, DENV-2, DENV-3 e DENV-4. A doenÃa pode manifestar-se como uma enfermidade infecciosa aguda, caracterizada por um amplo espectro clÃnico que varia desde formas de infecÃÃo assintomÃtica ou febre indiferenciada atà as formas graves, com hemorragia e/ou choque. Este estudo apresentou como objetivo descrever os aspectos epidemiolÃgicos, clÃnicos e laboratoriais de pacientes com suspeita de dengue atendidos no Hospital SÃo Josà de DoenÃas Infecciosas (HSJ) e no Hospital Nossa Senhora da ConceiÃÃo (HDNSC) no perÃodo de fevereiro a dezembro de 2010. Dessa forma, foram recrutados 93 pacientes, sendo que, 86 preencheram os critÃrios de inclusÃo. Os pacientes foram recrutados por busca ativa nas emergÃncias e nas enfermarias dos referidos hospitais e submetidos a um protocolo de acompanhamento por meio de uma ficha de avaliaÃÃo clÃnica inicial (1 ao 5Âdia de doenÃa) e de uma ficha de avaliaÃÃo subsequente (6 ao 7 dia de doenÃa). Foram realizadas pelo menos duas mensuraÃÃes de hematÃcrito, plaquetas, alÃm de exames bioquÃmicos e exames especÃficos para dengue. Os sinais e os sintomas mais prevalentes nos pacientes com suspeita de dengue foram: febre, cefaleia e mialgia. Vinte e cinco pacientes (29%) apresentavam manifestaÃÃes hemorrÃgicas espontÃneas, sendo que, as hemorragias cutÃneas (petÃquias e equimoses) foram as mais encontradas (15%). Quando avaliada a populaÃÃo feminina em idade reprodutiva, 6% apresentaram metrorragia. A prova do laÃo foi realizada em 80 pacientes, sendo positiva em 20 pacientes (25%). Dos 86 pacientes, 48 (55,8%) foram positivos para dengue por pelo menos uma das tÃcnicas: imunocromatografia NS1 (16%), RT-PCR (19%), ELISA IgM (44%), imunocromatografia IgM (42%) e ELISA NS1 (27%). O vÃrus dengue foi detectado em 16 pacientes, sendo, DENV-1 em 1 paciente (6,2%), DENV-2 em 14 pacientes (87,5%) e DENV-3 em 1 paciente (6,2%). Vinte e seis pacientes (54,1%) preencheram os critÃrios do MinistÃrio da SaÃde (MS) de Dengue ClÃssica (DC), 10 (20,8%) de Febre HemorrÃgica de Dengue (FHD) e 12 (25%) de Dengue com ComplicaÃÃo (DCC). A relaÃÃo entre sexo feminino e masculino foi de aproximadamente 1,1/1, com predomÃnio maior de adultos jovens. Quanto ao critÃrio de gravidade do MS, 60% dos casos suspeitos de dengue foram classificados como grau II e nenhum caso como grau IV. Dos critÃrios de extravasamento plasmÃtico preconizado pelo MS, a hipoalbuminemia esteve presente em 5 pacientes (10,4%). A queda do hematÃcrito acima de 20% apÃs hidrataÃÃo foi observada em apenas 4 pacientes (8,3%). No perÃodo do estudo, foram diagnosticados dois pacientes com dengue e leptospirose, sendo que um paciente complicou com pÃrpura trombocitopÃnica idiopÃtica, esses pacientes tiveram evoluÃÃo benigna. Portanto salientamos a necessidade de um diagnÃstico precoce, antes do desenvolvimento das manifestaÃÃes graves, de polÃticas de erradicaÃÃo do Aedes e da estruturaÃÃo de um serviÃo de referÃncia. / Dengue is transmitted by blood-sucking mosquitoes of the species of the genus Aedes aegypti and albopictus. Dengue virus (DENV) belongs to the genus Flavivirus of the Flaviviridae family and has four serotypes that were designated as: DENV-1, DENV-2, DENV-3 and DENV-4. The disease can manifest as an acute infectious disease characterized by a wide clinical spectrum ranging from asymptomatic forms of infection or undifferentiated fever to severe forms, with bleeding and / or shock. This study had as objective to describe the epidemiological, clinical and laboratory features of patients with suspected dengue fever treated at the St Joseph Hospital of Infectious Diseases (HSJ) and the Hospital Nossa Senhora da ConceiÃÃo (HDNSC) in the period from February to December 2010. Thus, we recruited 93 patients, 86 met the inclusion criteria. Patients were recruited by an active search in emergencies and in the ward of these hospitals and underwent a follow-up protocol through an initial clinical evaluation form (from day 1 to day 5 of illness) and an evaluation form following (from the 6 to 7 day of illness). Were performed at least two measurements of hematocrit, platelets, and biochemical tests and specific tests for dengue. The signs and symptoms more prevalent in patients with suspected dengue were fever, headache and myalgia. Twenty-five patients (29%) had spontaneous bleeding manifestations and the cutaneous bleeding (petechiae and ecchymosis) were the most frequent (15%). When evaluating the female population of reproductive age, 6% had metrorrhagia. The tourniquet test was performed in 80 patients and was positive in 20 patients. Of 86 patients, 48 (55,8%) were positive for dengue at least one of the techniques: immunochromatography NS1 (16%), RT-PCR (19%), IgM ELISA (44%), IgM immunochromatography (42%) and NS1 ELISA (27%). The dengue virus was detected in 16 patient and, DENV-1 in 1 patient (6.2%), DENV-2 in 14 patients (87.5%) and DENV-3 in 1 patient (6.2%). Twenty- six patients (54,1%) met the criteria of the Ministry of Health (MOH) Classic Dengue (DC), 10 (20,8%) of Dengue Hemorrhagic Fever (DHF) and 12 (25%) of Dengue with complication (DCC). The relationship bet ween females and males were approximately 1.1/1, with higher prevalence in young adults The criterion for severity of MOH, 60% of suspected dengue cases were classified as grade II and none as grade IV. Plasma extravasation of criteria recommended by MOH, hypoalbuminemia was present in 5 patients (10,4%). The drop in hematocrit higher than 20% after hydration was observed in only 4 patients (8,3%). During the study period, two patients were diagnosed with dengue and leptospirosis, and one patient complicated with idiopathic thrombocytopenic purpura, these patients had a benign outcome. Therefore we stress the need for early diagnosis, before the development of severe manifestations, of policies to eradicate Aedes and structure a reference service.
| Identifer | oai:union.ndltd.org:IBICT/oai:www.teses.ufc.br:5373 |
| Date | 27 February 2012 |
| Creators | Almira Maria Monteiro Gomes |
| Contributors | Danielle Malta Lima, RomÃlia Pinheiro GonÃalves Lemes, Fernanda Montenegro de Carvalho AraÃjo, Maria Izabel Florindo Guedes |
| Publisher | Universidade Federal do CearÃ, Programa de PÃs-GraduaÃÃo em Patologia, UFC, BR |
| Source Sets | IBICT Brazilian ETDs |
| Language | Portuguese |
| Detected Language | English |
| Type | info:eu-repo/semantics/publishedVersion, info:eu-repo/semantics/masterThesis |
| Format | application/pdf |
| Source | reponame:Biblioteca Digital de Teses e Dissertações da UFC, instname:Universidade Federal do Ceará, instacron:UFC |
| Rights | info:eu-repo/semantics/openAccess |
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